By Caiti Crum, VP of Therapy at Foresight
Last week a friend and I were on a six-mile run along the Embarcadero, a stretch of land that curves across the crest of the San Francisco peninsula and rolls under the Bay Bridge, also home to the Ferry Building, which hosts a world-renowned farmer’s market on Saturdays. The market was overflowing with the abundance of summer turning to fall. September marks the inflection point between growth and retreat with the Autumn Equinox. It is also, strangely to me, the month in which we acknowledge and advocate for Suicide Prevention.
We were about four miles into our run when we passed a gathering of about 400 people. Curious, we slowed down to see what brought these people together. I saw a couple of teenagers holding signs that read, “Welcome to Out of the Darkness” and “Walk with us to Prevent Suicide.”
Stopped in my tracks, I took in just how many people were gathered. A familiar, hollow pain bloomed from somewhere behind my sternum. I took a deep breath, ensuring that my rib cage expanded fully, exhaled, took another breath to deepen that stretch, and exhaled slowly. I tapped my friend’s arm, and we ran on. I ran in silence, focused on my breath. A few minutes later the pain eased off.
My Relationship with Suicide
I never expected to start my career as a therapist in an inpatient unit for children, while pregnant with my son. I spent the better part of a year at San Francisco’s McAuley Institute at Saint Mary’s hospital, working with children aged 11 to 18 who were hospitalized due to a psychiatric crisis. The unit was in a nearly abandoned part of the hospital and looked as you might expect: bars on the windows, with locks and industrial-grade furniture. Staff wore lanyards that pulled away if yanked. To this day, I close any door tightly behind me, checking the handle to ensure it latches. The kids wore ill-fitting scrubs and often came onto the unit smelling like dried blood and delousing shampoo and covered in bandages or casts.
Day after day I met with kids on “the milieu”— a large room with three round tables and a nursing station with large windows that had a perfect view of the UCSF campus. The room was bright and sunlit in contrast to the conversations. Over games of Apples to Apples, collaborative drawings, and doodles, the kids and I would walk through the routine of therapeutic work, discussing using one’s anger as a tool, self-advocacy, and gaining insight on reasons for self-destructive behavior and alternatives. The kids were the embodiment of resilience.
While there were tears and at times expressions of depthless rage, the milieu was a space where the kids shifted out of crisis. The concept of a psychiatric hold and its purpose became clear during this time; this was an exilic space, out of time and routine, that served to quickly bring someone back from the brink. All other work existed to keep the crisis from occurring at another time, in another place. I learned that a psychiatric hold, voluntary or not, is a traumatic act that subjugates a person’s basic rights, ensuring that they can’t hurt themselves or others in a brief state of profound life-or-death crisis. I also learned that this process should be an absolute last resort.
My perspective on suicide and loss continued to evolve as I gained clinical experience. The programs I supported and started focused on people who were frequently hospitalized or incarcerated. My private practice allowed me to develop skills as a therapist focused on grief work, and I pursued a certification in thanatology (a scientific discipline that examines death from many perspectives) to further hone my capacity to work with people, particularly those who’d lost a loved one to suicide. The frank and open discussions with clients left shattered in the wake of a loved one’s self-annihilation were challenging but rewarding. I felt comfortable with risk assessments, talking with people about suicide, and collaborating with others to support their ability to speak with their clients about content that would otherwise be left unspoken. Everywhere I looked, the rapport and trust required to truly attune to people coping with suicide in some capacity was the most critical component to therapeutic success and effective risk mitigation.
A Personal Loss
One beautiful, bright day, I got a call from an unknown number in Uganda. I knew it was my dear friend from school with whom I often collaborated on healthcare advocacy projects. I pulled over and answered the call. My friend’s voice sounded ragged. He was crying. Typically he was overflowing with energy, perpetually laughing, with a salty sense of humor. Something was truly wrong. “It’s Kevin, he’s dead, he shot himself,” he said.
Kevin was my friend’s younger brother and one of my best friends in college. He was consistently present for some of the most challenging points in my life. He hadn’t done anything earth shattering or unique, he simply showed up and listened, didn’t try to fix anything, and respected my boundaries without fail. Kevin had become a successful chef with a lovely family. His wide smile and wiry, frenetic form were featured on a reality show about food trucks and in the news as his restaurant gained acclaim. I hadn’t spoken with him since we’d both started our own families. Our communication was mainly in the form of emojis and comments on each others’ posts on Facebook. He looked genuinely happy, even joyful.
At that moment, on the side of the road, my bike resting against my hip, I was flooded with the feeling that I’d completely let Kevin down. I could barely breathe as I tried to console my friend. The shock took a while to wear off. As the months passed, I was able to accept with greater certainty the fact that Kevin was no longer here. When my friend and his wife shared that they’d spread some of his ashes at a festival in the desert, the certainty of his death finally stuck.
Being a survivor of a loved one’s suicide is a unique grief. Often displaced by distance, the wear of confusion, guilt, and the inability to do anything more to help, survivors of suicide are left with unresolved questions that make us feel powerless. Metabolizing grief as a survivor of suicide is a unique process due to the absence of conclusive, rationale explanations. We simply have to let go of searching for the “why” and find other meaning. These days, I notice my friend remarking that he, “wished Kevin were here to see ____.” I see this as a way for him to move forward without getting completely overwhelmed at every step.
September . . .
Returning to the present, my friend and I made our way back to the Ferry Building and the crowd had shifted into a march, with people holding signs, many drawn by children, advocating for suicide prevention. The contrast of people of every walk of life holding signs and crying or holding back tears with the crowds of people holding the abundance of summer in their arms—sunflowers, tomatoes, peaches—brought it all home for me.
September is the perfect month to amplify the awareness of Suicide Prevention. The marching survivors were a conduit between the people they loved who could find no alternative but to exit the planet and the people going about their day, seeking nourishment and companionship in a space brimming with vitality. Each community was moving forward, seeking life and connection while reckoning with mortality and unanswerable questions.
If you or someone you know is contemplating suicide, talk to someone or call or text 988 or chat 988lifeline.org, the 24/7 Suicide & Crisis Lifeline. When you are out of crisis and looking for support and strategies to help you cope, please contact Foresight. Our dedicated team of licensed mental health professionals is ready to help.